Provider Demographics
NPI:1255444683
Name:OLIPHANT, KIMBERLEY A (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:A
Last Name:OLIPHANT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:KIMBERLEY
Other - Middle Name:A
Other - Last Name:PLOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:P.O. BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1449
Mailing Address - Fax:239-424-1421
Practice Address - Street 1:1435 S.E. 8TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3289
Practice Address - Country:US
Practice Address - Phone:239-424-2757
Practice Address - Fax:239-772-0186
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000328363LF0000X
FLARNP9397535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily